Asthma inhalers adopted more slowly
for minority patients and childrenStudy analyzes how usage of new technology
may contribute to health care disparities

BOSTON - December 23, 2005 - Inhaled steroid medications
for asthma, which have greatly reduced the need for patients to
be hospitalized with serious symptoms, were significantly less likely
to be prescribed for minority patients and children during the years
soon after their introduction. In the January 2006 issue of the
journal Medical Care, investigators from the Massachusetts
General Hospital Institute
for Health Policy report one of the first studies to examine
how disparitites in health care change over time, reflecting how
the introduction of a new technology differs among racial, ethnic
or other groups.

"Previous studies of health care disparities have tended to
look at one point in time, but a longer-term picture allows us to
see whether disparities are a static or dynamic problem," says
Timothy Ferris, MD, of the MGH Institute for Health Policy, the
article's lead author. "Our results support the theory that
disparities might be greater in the early stages after a technology
is introduced and that attempts to reduce disparities might focus
on this important period."

In order to track the adoption of inhaled steroid medications for
asthma after their introduction in the 1980s, the researchers analyzed
data from the National Ambulatory Medical Care Survey from 1989
to 1998. In this annual survey, conducted by the National Center
for Health Statistics, physicians complete a form after outpatient
visits during a randomly selected week, answering questions about
patients' diagnoses and the treatments provided. The researchers
identified 3,671 physician visits by patients with asthma during
the years studied, determined whether or not inhaled steroids were
prescribed or administered during those visits, and also analyzed
information on patients' age and race or ethnicity.

During the first two years studied, minority patients were less
than half as likely to receive inhaled steroid medications as were
non-minority patients. While the overall difference in usage between
minority and non-minority patients resolved by the mid-1990s, that
change reflected increased usage only among African American patients;
the low rate of prescription for Hispanic patients remained virtually
unchanged. Children also were significantly less likely than adults
to receive inhaled steroid medications throughout the years studied,
although there was some increase in usage for the youngest children.

"Technology adoption in health care requires both the doctor
to recommend a new agent and the patient to accept it. Many if not
most of the steps in that process are not controlled by the patient,"
Ferris says. "Some factors behind these disparities might be
the greater access non-minority patients usually have to specialists,
who are more likely to use new technologies, and the higher cost
of new medications, which makes them less accessible to the poor
and underinsured. Children often do not get access to new technologies
because drug manufacturers may not invest in the trials required
to demonstrate safety and effectiveness in children. When you put
these factors together, it appears that the minority children were
the last to benefit from this effective medication."

The researchers also note that there is no way of knowing the correct
usage rate for these medications among the various groups. For example,
while usage differences between white and black patients seemed
to disappear, black patients might still be undertreated, since
asthma is more common and often more serious among African Americans.
Further studies of factors underlying these and other disparities
are being conducted by the Disparities Solutions Center in the MGH
Institute for Health Policy.

Co-authors of the study are Karen Kuhlthau, PhD, and James Perrin,
MD, of the MGH Center for Child and Adolescent Health Policy; John
Ausiello, of the MGH Institute for Health Policy; and Robert Kahn,
MD, MPH, Cincinnati Children's Medical Center.

Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of nearly $500 million and
major research centers in AIDS, cardiovascular research, cancer,
cutaneous biology, medical imaging, neurodegenerative disorders,
transplantation biology and photomedicine. In 1994, MGH and Brigham
and Women's Hospital joined to form Partners HealthCare System,
an integrated health care delivery system comprising the two academic
medical centers, specialty and community hospitals, a network of
physician groups, and nonacute and home health services.